Update 21 December 2020
The identification of a new variant of COVID-19, combined with rapidly rising case numbers in London and the south-east of England, has led to the introduction of a new tier 4 level of lockdown in these regions. Meanwhile, many other countries are closing their borders to UK passengers and France has halted the arrival of freight across the channel for fear of the variant spreading elsewhere.
The Chief Medical Officer for England, Professor Chris Whitty, has said that whilst the new strain is considered to spread more quickly there is no current evidence to suggest it causes a more severe illness or that the new vaccines will not work against it. (1)
Although the UK is dominating the headlines as the source of this new variant it has been identified in many other places including the Netherlands, Denmark and Australia.
Along with the UK, these countries all have something in common – they have the ability to analyse the genetic make-up of the virus. 10% of all those who test positive for COVID-19 in the UK also have their viruses genetically sequenced. This means these countries are always going to be amongst the first to identify a new strain. It may be spreading rapidly elsewhere but going undetected. (2)
The UK has one of the most advanced Genome Sequencing services in the world and so would be expected to be amongst the first to identify new strains. COVID-19 test results alone do not tell you which strain the virus is, the test has to be analysed in a highly specialised laboratory few countries have. (3) (4)
The EDCD (European Centre for Disease Prevention and Control) have included in their official announcement about the new variant the fact that “...most EU/EEA countries sequence much smaller proportions of virus isolates than the UK, so ongoing circulation of this variant outside of the UK cannot be excluded.” (5)
Whilst work is ongoing to learn more about this latest variant, and it must be remembered that viruses are expected to mutate and change so this is a familiar concept for scientists, the fact is COVID-19 cases are rising rapidly in the UK and elsewhere in the world. Even if it is established that this variant causes less severe disease, if it becomes more common overall then it could still lead to more people in hospital.
In simple figures, if the risk of becoming seriously ill and needing an ITU bed is 1 in 100 for the original COVID-19 virus but lower at 1 in 1000 for this new variant, it would be easy to be complacent and regard the new variant as less serious despite being more infectious.
However, if the new variant is now the dominating virus in the majority of cases of COVID-19, imagine a scenario of 20,000 cases of COVID-19 where 19,000 of the cases are caused by the new variant and only 1,000 by the original virus. This would mean 19 people from the group of 19,000 with the new variant need an ITU bed – compared to only 10 of the people with the original virus.
As ever with this virus, it comes down to the numbers and just how much hospitals can cope with before they are overwhelmed. Multiple these figures up to the reality facing the NHS and very quickly more beds than ever will be needed for people with COVID-19 if this variant proves to be more infectious even if it less likely to hospitalise any one individual.
That is why, yet again, action similar to that back in March 2020 is needed to contain the spread of infection. This time however we have a better understanding of how to treat COVID-19 and several vaccines on the horizon. This new phase will not be forever but we need to endure it at the present time.
(2) https://theconversation.com/coronavirus-new-variant-genomics-researcher-answers-key-questions-152381
Original Piece 16 December 2020
The announcement on 14 December 2020 that a “new strain of COVID-19” is spreading through London and the south east of England has led to a variety of fear-inducing newspaper headlines over the last two days. (1)
The most sensible and level-headed reporting on this new development is, in my opinion, this piece here by the science correspondent Tom Clarke and is based on the science and everything we know so far.
Rather than re-write a sound article, I shall instead focus on some common questions I have been asked.
What actually is a mutation?
The word “mutation” is often used in the media and films to signify something dangerous, alien and/or deadly. Scientifically it simply means a change in the genetic makeup of a living organism. These changes are needed for the process of evolution of a species and can be a change for the better, allowing an organism to adapt to its environment and survive. Other mutations have deleterious effects, for example cancer is caused by gene mutations. (2) (3)
Of itself, “mutation” is a neutral term and does not imply a good or bad process, only a natural one. Whilst some viruses can mutate to become more serious, it is just as possible for a virus to mutate into a less deadly form and cease to cause serious illness. (4)
How often do viruses mutate?
All viruses mutate, some more than others. In the virus world, coronaviruses do not mutate as much as some do, for example the flu virus. Despite this they will still mutate two to three times a month and there are currently around 12,000 (yes, twelve thousand) recognised mutations of the COVID-19 virus. (5) (6) (7)
Some of the COVID-19 mutations have been given names, for example the "Spanish Strain" that emerged in the summer, and the Danish "mink strain" that appeared in the autumn but we now know that neither of these were more or less transmissible or serious than previous strains of the virus. (8) (9)
So what has happened in London with COVID-19?
Scientists have identified another variant of the virus primarily in areas of the UK that currently have the highest number of COVID-19 cases, namely London and parts of the south east of England. However what is not yet known is whether this new variant is more infectious and is causing more cases or if in those areas with higher numbers more cases of this particular variation of the virus are simply being picked up.
To use an everyday analogy, if you enter a raffle that has just one winning ticket out of 100 total tickets, the person who buys five tickets is less likely to find that one winning ticket than the person who buys fifty tickets. The first person has a 5% chance of finding the winning ticket, the second has a 50% chance BUT the winning ticket itself is simply just sitting there, it is just more likely to be found by the second person. This COVID-19 variant may simply be easier to find in the south of England because of the higher overall number of cases, it does not follow that it is the cause of the rise in cases. (10)
Porton Down is now involved, that surely means this is more serious?
Scientists at Public Health England's lab in Porton Down in Wiltshire are indeed now growing samples of this latest virus variant. Porton Down is often referred to as England’s “top secret laboratory”, partly because it is where research into chemical weapons and deadly diseases such as Ebola and anthrax is carried out. It is also where scientists established that the chemical nerve agent Novichok had been used to poison the former Russian spy Sergei Skripal and his daughter in March 2018. (11)
As a doctor I would be more concerned if it wasn’t being studied at Porton Down. With any new virus it needs to be studied in a biosecure laboratory with quick turnaround times. Standard hospital and university laboratories cannot offer this, Porton Down can. It has already played a significant role in development of the vaccine and is the best placed laboratory to study the virus in safety. (12)
Will the vaccine still work if the virus keeps changing?
The current mutation is affecting a tiny piece of the spike proteins - those club-like projections seen on the surface of the virus. The vaccine works against the entire spike protein, not just one part of it. To get round the vaccine, the coronavirus would have to alter the entire spike protein structure which would be a mammoth task for any virus. Even then the technology behind the vaccine means it could soon be modified to incorporate a new pool of spike proteins. (13)
Can a mutation ever be a good thing?
Yes, it can. Some mutations can weaken the ability of the virus to bind to human cells and thereby reduce the virulence of the infection. It is also possible that a mutation can make a disease more infectious but less serious so that although more people catch it, fewer become significantly unwell with it. More cases of infection, but with a less serious illness, would be a positive outcome overall. (14)
In Conclusion
The emergence of different coronavirus strains is to be expected. All viruses mutate and coronaviruses are relatively stable compared to some other viruses such as the flu virus. Even so there are at least 12,000 documented variants of the COVID-19 virus now. Each new variant is closely studied by scientists and there is currently no evidence to suggest any variant is causing more serious disease in people. Updating vaccines (if necessary) will be possible as the technology is now in place to do this.
(7) https://www.newscientist.com/article/2263077-what-you-need-to-know-about-the-new-variant-of-coronavirus-in-the-uk/
(10) https://www.sciencemediacentre.org/expert-reaction-to-the-new-variant-of-sars-cov-2/?cli_action=1608024763.961 Comment by Prof Jonathan Stoye
(13) https://www.sciencemediacentre.org/expert-reaction-to-the-new-variant-of-sars-cov-2/?cli_action=1608024763.961 Comments by Prof Julian Hiscox & Prof Martin Hibberd
(14) https://www.sciencemediacentre.org/expert-reaction-to-the-new-variant-of-sars-cov-2/?cli_action=1608024763.961 Comments by Prof Brendan Wren & Dr Andrew Davidson
